Organization
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHAPIRO (VP, CONTROLLER)
(410) 832-7790
Entity
Organization
Contact information
Practice address
6508 DEER POINTE DR, SUITE A, SALISBURY, MD 21804
(410) 543-1957
(410) 543-8942
Mailing address
PO BOX 62946, BALTIMORE, MD 21264-2946
(410) 494-7607
(610) 925-7387
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999320700
—
MD
05
—
999320705
—
MD
01
—
B018
CAREFIRST BCBS OF NCA GP
DC
01
—
KQ54GE
CAREFIRST BCBS OF MD GP #
MD
Enumeration date
06/09/2006
Last updated
08/05/2019
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